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COMPLIMENTS    OF    THE  AUTHOR. 


Feigned  Insanity. 


REPORT  OF  THREE  CASES, 


BY   WILLIAM    FRANCIS   DREWRYs   M.  D., 

OF  PETEESBURG,  VA., 

First  Assistant  Physician  Central  State  Hospital. 


Digitized  by  the  Internet  Archive 
in  2014 


https://archive.org/details/feignedinsanityrOOdrew 


FEIGNED  insanity; 


BY   WILLIAM   FliANCIS   DREWliY,   M.  D., 
OF   PETERSJU  KtJ,  VA., 

First  Assistant  Physiaian  Central  State  Hospital. 


The  simulation  of  iusaiiity  is  iiot  an  iouovation  peculiar  to 
Dioderu  day  schemers,  though  it  is  now  Imiuently  resorted  to 
by  designing  criminals. 

In  the  sacred  writings  it  is  recorded  that  the  Shepherd  King 
of  Israel  "changed  his  behavior  and  feigned  himself  mad  and 
scrabbled  on  the  doors  of  the  gate,  and  let  his  spittle  fall  down 
upon  his  beard , ' '  because  he  was  '  ^sore  afraid  of  the  King  of  Gath . ' ' 

In  order  to  escape  the  Trojan  war,  Ulysses  feigned  insanity 
by  ploughing  the  seashore  and  sowing  salt  instead  of  corn,  and 
and  Lucius  Junius  Brutus,  it  is  said,  played  the  imbecile  for  a 
purpose. 

To  detect  simulation  and  to  establish  the  requisite  proof  of 
it,  have  at  all  times  been  matters  of  more  or  less  dif^icult3^  Cas- 
per met  with  many  cases  of  the  sort  and  appreciated  the  diffi- 
culties which  they  presented.  Says  Hammond:  "N^o  one,  no 
matter  how  skillful  an  alienist  he  may  be,  is  beyond  the  point  of 
being  imposed  upon  for  a  short  time  by  persons  assuming  to  have 
certain  forms  of  mental  derangement.  Snell  remarks  that  if  a 
simulator  preserves  a  complete  passiveness  and  an  obstinate  si- 
lence, it  is  not  impossible  that  insanitj^  may  be  so  perfectly  sim- 
ulated that  detection  may  not  be  accomplished.  Conolly  I^or- 
man  regards  the  question  of  simulation  of  insanity  as  "one  of  the 
most  difficult  with  which  alienists  have  to  deal,  one  requiring 
much  experience,  acumen  and  sagacity,  if  a  satisfactory  deci- 
sion is  to  be  arrived  at." 

In  his  work  on  "Sanity  and  Insanity,"  Merciersays:  "There 
is  no  form  of  insanity  that  may  not  be  simulated  by  a  case  of 

■Read  before  the  section  of  Neurology  and  Medical  Jurisprudeuce, 
American  Medical  Association,  meeting  at  Atlanta,  May,  1896. 


2 

(Iriiiikouiiess;  aud  wbeu  it  is  uot  known,  from  other  sources  of 
information,  that  these  manifestations  are  due  to  drink,  no  ex- 
pert in  the  world,  however  skillful,  could  distinguish  between 
the  insanity  that  is  due  to  alcoholic  poison  and  the  insanity  that 
is  due  to  other  causes." 

Tardieu  and  others  think,  however,  that  nothing  is  more  dif- 
ficult to  counterfeit  than  mental  disease,  and  that  the  attempt  to 
deceive  may  be  easily  discovered  by  a  careful  observer.  Conolly 
asserts  that  he  can  ^'hardly  imagine  a  case  which  would  be  proof 
against  an  efficient  system  of  observation. - 

When  we  remember  that,  besides  the  fact  that  scores  of  crimi- 
nals resort  to  the  insanity  dodge  to  escape  merited  punishment, 
the  truly  insane  sometimes  simulate  insanity,  that  simulation 
itself  may  be  an  indication  of  mental  alienation,  and  that  occa- 
sionally there  is  a  tendency  of  feigned  insanity  after  long  dura- 
tion to  become  real  insanity,  the  question  of  accurate  diagnosis 
may  not  always  be  unattended  with  uncertainty  and  embarrass- 
ment. To  an  experienced  and  competent  alienist  there  will  of 
course  seldom  be  any  great  difficulty  in  arriving  at  a  correct  con- 
clusion, but  to  one  with  more  or  less  limited  knowledge  of  the 
various  manifestations  of  mental  diseases,  a  clever  imposter,  with 
the  faculty  of  imitation  well  developed,  would  appear  somewhat 
in  the  nature  of  a  psychical  problem. 

At  all  events,  before  giving  a  positive  answer  to  so  delicate 
and  important  a  question  as  whether  one  is  insane,  and  there- 
fore entitled  to  all  possible  humane  consideration,  or  sane,  and 
consequently  responsible  for  his  illegal  acts,  a  physician  should 
study  methodically  and  scientifically  the  suspected  case,  keep- 
ing his  conscience  pure  and  undefiled  under  all  circumstances. 
^'His  opinion,"  says  an  eminent  authority,  ^ ^should  be  founded 
upon  the  conception  of  pure  knowledge,  based  upon  observation 
and  induction." 

The  question  of  disease — that  and  nothing  more — is  the  one 
for  the  physician  to  determine.  Is  the  person,  whose  legal  or  tes- 
tamentary responsibility  is  in  doubt,  insane — is  his  mind  affected 
by  disease  f  That's  the  problem,  the  solution  of  which  devolves 
upon  the  physician.  Says  Bucknill:  ''The  element  of  disease 
in  abnormal  conditions  of  mind  is  the  touchstone  of  irresponsi- 
bility aud  the  detection  of  its  existence  or  non-existence,  is  the 
peculiar  and  oftentimes  the  difficult  task  of  the  pyschologist." 

So,  view  the  matter  in  any  way  you  will,  it  can  be  only  a 
question  of  diagnosis. 


8 


CASE  1. 

In  February,  1895,  Isaiah  P.  was  indicted  on  the  charge  of 
house-breaking  and  larceny.  While  in  jail  awaiting  his  trial  in 
the  hustings  court  of  a  Virginia  city,  he  suddenly  began  acting 
so  strangely  that  doubt  was  entertained  regarding  his  mental 
condition.  Upon  being  arraigned  in  court  his  behavior  was  so 
utterly  at  variance  with  that  of  an  ordinary  sane  man,  he  was 
remanded  to  jail  and  the  trial  of  his  case  postponed,  so  that  his 
mental  condition  might  be  investigated. 

The  judge  appointed  the  writer  to  ascertain  v/hether  or  not  the 
prisoner  was  insane.  Whereupon  I  visited  him  several  times, 
dealt  with  him  not  in  the  role  of  a  secret  detective,  but  in  that  of 
an  impartial  physician,  and  as  such  proceeded  systematically  to 
inform  myself  as  full}'  as  possible  of  his  history  and  symptoms. 

Sistory  and  Heredity. — Isaiah  was  born,  in  1857,  of  negro  par- 
entage. There  was  nothing  of  special  interest  connected  with 
his  early  life.  From  childhood  he  was  a  bad,  indolent  fellow. 
Only  two  of  his  family  were  ever  afflicted  with  any  form  of  neu- 
rosis or  of  psychosis.  His  mother,  at  sixty -five,  was  sent  to  an 
asylum  in  a  state  of  senile  dementia.  A  younger  sister  died  of 
phthisis  pulmonalis,  complicated  with  melancholia,  while  in 
a  hospital. 

During  a  spree  Isaiah  received  a  blow  on  the  right  side  of  his 
head,  which  produced  a  depressed  fracture,  but  under  careful 
surgical  treatment  he  made  a  complete  recovery,  the  only  visible 
results  remaining  being  a  slight  depression  in  the  cranium.  On 
more  than  one  occasion  he  was  suspected  of  larceny,  and  finally, 
in  1888,  was  convicted  and  sentenced  to  five  years  confinement 
in  the  State  penitentiary. 

It  was  claimed  by  his  family  that  he  had  had,  since  the  blow 
on  the  head,  several  epileptic  fits  and  been  at  times  ''curious  in 
his  ways."  But  in  the  absence  of  corroborative  evidence  these 
statements  were  accepted  with  a  degree  of  reserve. 

Appearance,  Manner  and  Symptoms. — A  careful  physical  exam- 
ination revealed  nothing  of  special  pathologic  import.  His 
bodily  condition  was  about  normal. 

He  came  into  my  presence  with  an  air  of  exagerated  excite- 
ment, moved  about  restlessly,  took  no  notice  of  his  surround- 
ings, looked  wild  and  uneasy,  talked  incessantly  and  foolishly. 
The  almost  exclusive  subject  of  his  foolish,  incoherent  gibberish 
was  locusts.  He  talked  about  locusts  nearly  all  the  time,  but  when 
questioned  he  gave  answers  foreign  to  the  subject  of  his  apparent 


4 

or  assiiiiied  deliisioii,  saying-  he  did  not  uiiderstaud  what  I 
meant.  All  questions  were  answered  very  slowly  and  hesita- 
tingly. When  T  told  him  my  bnsiness  his  incoherence  and  rest- 
lessness became  intensified.  When  unobserved  he  became 
quiet  and  composed. 

Odd  sensations  in  his  head  were  frequently  complained  of. 
He  would  put  his  hand  to  his  head  and  say,  "something  is 
scrambling  about  in  here.'' 

Memory  and  intelligence,  to  all  appearances,  were  absolutely 
lost.  Apparently  he  recalled  nothing  that  had  ever  happened, 
nor  remembered  any  person  or  place  he  had  ever  seen.  He  could 
not  or  would  not  distinguish  one  piece  of  money  from  another, 
nor  tell  a  man  from  a  woman. 

To  every  question  he  gave  a  negative  or  an  absurd  reply.  For 
instance: 

(Question — Where  were  you  born  1 

Ansiver — Caught  ninety-nine  locusts  to-day. 

Question — How  do  you  feel  to-day? 

Answer — Eat  locusts  with  butter. 

Question.  Let  me  see  your  tongue? 

Answer — Holds  up  his  foot. 

Question — Did  you  sleep  well  last  night? 

Answer — Tell  him  all  right.    Here  they  come. 

Question — Tell  me  about  the  locusts  ? 

Answer — Had  bread  and  shucl^s  for  dinner. 

Question — But  what  of  the  locusts  f 

Answer — I donH  understand  yon. 

Question — How  long  has  your  mind  been  affected  this  way  ? 

Answer — Some  say  forty-nine  years.    I  say  one  hundred. 

Question — Have  you  heard  from  home  lately  ? 

Answer — Fell  in  the  river  last  night.  The  locusts  are  rolling  down 
the  mountains.    Let  them  roll. 

He  slept  well  several  hours  every  night,  and  frequently  in  the 
daytime  after  he  had  become  very  tired  from  constant  exertion 
and  excitement. 

I  took  occasion  to  remark  in  an  undertone  to  the  jailor  that, 
if  the  patient  were  to  sing,  become  uoisy  at  night,  destructive  to 
clothing,  filthy  in  his  habits,  devoid  of  the  sense  of  pain,  my  be- 
lief in  his  insanity  would  be  confirmed.  A  few  days  later  Isaiah 
had  become  so  noisy  and  filthy  at  night  that  he  had  to  be  iso- 
lated. He  had  tried  to  be  wakeful,  but,  negro-like,  he  soon  fell 
asleep.  His  clothes  were  torn,  shoes  thrown  away,  coat  reversed. 


&G.  T  thrust  a  needle  into  his  iiesh  at  various  points,  without 
making  any  perceptible  impression.  Said  he  did  not  feel  any 
pain  at  all.  A  few  minutes  later,  when  a  needle  was  suddenly 
struck  into  his  back,  he  forgot  to  be  insensible  to  pain,  and  con- 
sequently jumped  some  distance. 

My  notes  show  many  and  various  evidences  of  Isaiah's  clumsy 
effort  to  ''play  crazy,"  but  the  above  is  quite  sufficient  to  prove 
beyond  any  doubt,  similation.  I  had  no  trouble  in  detecting  the 
fraud. 

For  two  months — in  fact,  until  the  day  he  was  taken  to  the 
penitentiary  to  serve  out  a  23 -year  sentence — he  continued  his 
efforts  to  deceive.  Finally,  however,  he  acknowledged  the  at- 
tempted fraud. 

In  my  statement  to  the  Court  and  jury  I  gave,  in  substance, 
the  following  as  the  grounds  upon  which  I  based  my  opinions : 

1.  There  was  no  prodromal  stage  of  indisposition,  malaise  or  de- 
pression preceding  the  sudden  outbreak.  The  attack  occurred  in 
the  midst  of  normal  health .  He  had  few  symptoms  of  any  form 
of  insanity  which  might  begin  somewhat  suddenly,  viz:  transi- 
tory mania,  epileptic  mania,  confusional  insanity,  acute  halluci- 
natory insanity,  alcoholic  mania,  none  of  which  it  is  possible  to 
counterfeit.  Then,  the  fixedness  of  the  form  of  delusion  he  tried 
to  imitate  would  exclude  any  of  the  above  types  of  insanity. 

2.  Sudden  development  of  a  fixed  delusion  regarding  one  par- 
ticular subject  is  not  consistent  with  the  clinical  history  of  any 
known  form  of  insanity;  for  paranoia,  monomania  or  delusional 
insanity,  is  of  slow  and  gradual  development  and  generally  un- 
attended with  any  special  excitement,  loss  of  intelligence,  &c. 

3.  If  he  were  trying  to  appear  a  paranoiac  or  monomaniac,  he 
overlooked  many  essential  points;  for  instance,  when  questioned 
regarding  his  delusion,  he  invariably  gave  an  answer  entirely 
foreign  to  the  subject;  and  the  peculiarity  of  expression  which 
so  strongly  marks  that  class  of  cases,  was  entirely  wanting;  and, 
furthermore,  there  was  no  excitement  or  irritability  of  temper 
when  contradicted. 

4.  Loss  of  memory,  reason  and  intelligence  would  occur  in 
dementia,  but  the  quickness  with  which  he  carried  out  my  sug- 
gestions regarding  the  "lacking  symptoms"  of  insanity,  to  say 
nothing  about  his  appearance  and  general  shrewdness,  would 
preclude  any  suspicion  of  mental  decay. 

5.  Contrary  to  what  is  observed  in  acute  mania  and  some  other 
forms  of  insanity,  there  was  no  sign  of  insomnia.    The  more  in 


6 

teuse  his  restlessuess,  the  more  profoimd  the  sleep  which  fol- 
lowed . 

6.  The  hesitancy,  extravagance  and  silliness  with  which  he 
replied  to  simple  ((uestions;  the  absurd,  disordered  ideas  which 
llowed  slowly  and  thoughtfully  would  not  be  exhibited  in  the 
real  maniac,  whose  ideas  form  and  flow  rapidly,  disconnectedly, 
and  are  not  devoid  of  sense. 

7.  There  were  no  physical  symptoms  upon  which  to  base  a  di- 
agnosis of  either  functional  or  organic  disease  of  the  brain.  The 
injury  to  the  head  had  left  no  perceptible  ill  results,  motor,  sen- 
sory or  mental.    A  slight  depression  marked  the  site  of  the  blow. 

8.  The  insanity  of  his  mother  being  a  psychosis  of  old  age,  could 
have  but  little  effect,  if  any,  in  the  offspring  of  her  early  life. 
But  the  facts  that  his  mother  was  insane  and  that  he  had  an  in- 
sane and  phthisical  sister  might  be  considered,  in  connection 
with  the  possible  effects  of  the  blow  on  the  head,  sufficient 
grounds  upon  which  a  neurotic  diathesis  or  nervous  instability 
might  be  based.  It  is  of  course  possible  that  the  head  injury 
might  have  caused  some  moral  deficiency. 

9.  The  order  of  development  and  the  assumed  symptoms  failed 
to  conform  to  the  complete  clinical  picture  of  any  recognized  type 
of  mental  disease. 

10.  The  motive  for  feigning  was  not  overlooked,  though  that 
was  of  secondary  importance  when  compared  with  the  history 
and  symptoms  of  the  case. 

CASE  2. 

Another  instance  of  a  criminal  trying  to  escape  the  stern  edict 
of  the  law  by  pretending  to  be  insane,  has  lately  come  under  my 
personal  observation.  In  this  case,  however,  the  ultimate  pur- 
pose of  the  malingerer  was  accomplished. 

Isaac  H.,  a  negro  youth,  had  served  a  few  months  of  an  18- 
year  sentence  in  the  state  prison,  for  murder.  He  assumed  the 
role  of  a  madman,  and  by  taking  advantage  of  the  lax  and  crude 
method  of  adjudging  one  insane  in  Virginia,  succeeded  in 
gaining  admission  to  the  insane  asylum,  where  no  special  ar- 
rangements are  provided  for  the  custody  of  insane  criminals. 
Every  possible  precaution  was  exercised  to  prevent  his  escape, 
yet  he,  after  a  short  sojourn,  very  ingeniously  gained  his 
liberty  and  has  never  since  been  heard  of.  We  had  diagnosed 
the  case  correctly  and  were  contemplating  returning  the  prisoner 
to  his  legitimate  abode.  I  have  not  time  here  to  make  a  thor- 
ough analysis  of  the  case.    Suffice  it  to  say,  he  so  far  overacted 


7 

the  part,  and  behaved  so  differently  from  any  other  case  of  acute 
mania — the  form  of  insanity  he  was  trying-  to  counterfeit — the 
deception  was  too  flagrant. 

The  history  of  the  case,  the  clumsy,  overacted  symptoms,  the 
motive,  were  all  carefully  studied,  and  by  a  process  of  elimina- 
tion, no  type  of  insanity  was  left  to  fit  his  case.  In  the  words  of 
the  distinguished  Dr.  Ohapin,  of  Philadelphia,  "The  method  of 
arriving  at  a  conclusion  is,  bring  together  all  the  features  in  the 
history  and  manifestations  of  the  case  and  then  decide  whether 
the  case  corresponds  to  a  type  of  insanity,  which  in  all  of  its 
features  could  not  be  simulated  except  by  a  trained  alienist.  In 
this  way  a  mistake  will  rarely  be  made." 

CASE 

Some  years  ago  there  was  admitted  into  the  Central  Hospital 
a  3^oung  colored  girl,  of  intelligence  above  the  average  of  her 
race,  and  with  a  physical  formation  well  nigh  perfect.  Her  case 
had  been  diagnosed  "epileptic  insanity." 

It  was  some  time  before  I  had  an  opportunity  of  seeing  her 
"in  a  fit."  From  the  post-epileptic  condition  I  had  serious 
doubts  about  the  genuineness  of  the  epilepsy.  Eventually  I  saw 
her  repeatedly  in  her  "terrible  attacks,"  as  her  family  had  des- 
ignated the  seizures. 

She  would  cry  out  suddenly,  then  fall,  snap  her  jaws  together, 
make  a  noise  like  the  bark  of  a  dog,  foam  at  the  mouth,  and  act 
most  maniacally,  &c.  Then  she  would  pass  in  a  convulsive 
state,  jerk  violently,  tear  off  all  her  clothes,  assume  the  opis- 
thotonos position,  grind  her  teeth,  strike  and  snap  at  everything 
in  reach,  and  finally  pass  into  a  quiet  sleep.  These  violent  at- 
tacks would  continue  sometimes  for  an  hour  or  two,  after  which 
the  patient  would  become  quiet  and  composed,  her  only  com- 
plaint being  that  she  felt  sore.  Said  she  knew  nothing  of  the  at 
tacks,  when  they  came  on  or  how  they  affected  her,  but  ex- 
pressed great  mortification  on  account  of  her  affliction. 

I  noticed  that  the  fall  was  rather  guarded,  that  she  never  bit 
her  tongue  or  hurt  herself  in  any  way,  that  the  sphincters  were 
never  relaxed,  that  the  pupils  were  in  every  way  normal,  the 
iris  not  insensible  to  light.  It  was  evident  that  sensory  percep- 
tion existed.  She  became  bathed  in  hot  perspiration,  and 
seemed  to  be  well  nigh  exhausted. 

The  assumed  tonic  and  clonic  convulsions  were  by  no  means 
like  those  seen  in  real  epilepsy.  The  post-epileptic  condition 
she  made  no  attempt  to  imitate. 


8 

The  girl  was  carefully  uursed  for  some  time,  but  after  watch- 
ing her  curious  manoeuvres  for  a  few  times,  I  told  her  that  she 
was  feigning  and  that  the  next  attack  she  had  I  should  put  her 
in  a  room  and  pay  no  attention  to  her  whatever.  My  threat  was 
promptly  carried  into  execution,  and  the  effect  was  all  that  could 
have  been  desired. 

She  was  soon  sent  home,  got  married,  though  has  never  had 
any  children,  and  has  ever  since  remained  free  from  that  ''epi- 
leptic insanity"  which  she  palmed  oft*  so  successfully  on  some  of 
her  friends  for  the  sole  purpose,  as  far  as  I  could  discern,  of 
arousing  sympathy.  There  was  doubtless  some  hysteria  in  her 
case. 

That  there  is  no  established  rule  or  test  by  which  feigned  in- 
sanity may  be  detected,  but  that  each  case  must  be  decided  upon 
according  to  the  history  and  symptoms  presented,  cannot  be  well 
denied.  Alienists  everywhere  will  bear  me  out  in  these  asser- 
tions. The  individual  whose  sanity  or  insanity  is  being  ques- 
tioned should  constitute  the  chief  object  of  the  investigation. 

Whenever  there  is  any  doubt  about  the  mental  condition  of 
one  charged  with  crime,  it  would  be  well,  in  my  humble  judg- 
ment, for  the  court  to  select  a  committee  of  competent  alienists 
to  investigate  the  case  and  report  in  writing  the  result  of  their 
examinations  and  deliberations.  This  need  not  preclude  a  cross- 
examination  . 

In  Russia  and  elsewhere  methods  similar  to  this  prevail.  In 
some  of  the  countries  there  is  a  regular  court  physician  who  de- 
cides all  doubtful  medical  cases.  It  has  been  advocated  in  some 
quarters  that  there  be  appointed  state  experts  in  insanity  to  act 
in  all  cases  where  an  element  of  uncertainty  exists. 

But  the  best  plan,  probably,  would  be  to  transfer  the  suspect 
to  an  insane  asylum  and  keep  him  there,  under  proper  safe- 
guard, for  a  specified  time,  in  order  that  the  attending  physicians 
may  determine  the  question  of  real  or  counterfeited  insanity. 

For  the  reasons  that  the  position  often  taken  by  lawyers  is  so 
entirely  at  variance  with  the  true  conception  of  the  disease — in- 
sanity,— that  medical  witnesses,  who  have  no  special  knowl- 
edge of  insanity,  are  often  called  upon  to  give  expert  testimony, 
and  that  physicians  are  sometimes  utilized  by  shrewd  counsel, 
for  partizan  or  for  sinister  purposes,  that  juries  composed  entirely 
of  laymen  are  not  competent  to  try  a  case  which  involves  a  ques- 
tion of  mental  alienation — brain  disease, — and  finally  and  chiefly, 
that  the  ends  of  justice  and  mercy  are  sometimes  thwarted,  our 
system  of  medical  jurisprudence  of  insanity  is  in  need  of  revision. 


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MED,  CENTER  UBi 

HISTORIOAU 
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